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      Early response to the emergence of influenza A(H7N9) virus in humans in China: the central role of prompt information sharing and public communication Translated title: ?????? ????? ?? ????????? ?????? ?????? A (H7N9) ? ????????? ? ?????: ??????????? ???? ???????????? ?????? ??????????? ? ?????????????? ?????????????? Translated title: Réponse précoce à l'émergence du virus de la grippe A(H7N9) chez l'homme en Chine: le rôle central du partage rapide des informations et de la communication publique Translated title: الاستجابة المبكرة لظهور فيروس الأنفلونزا A(H7N9) لدى البشر في الصين: الدور المركزي للتبادل الفوري للمعلومات والاتصال العام Translated title: ????????H7N9??????????????????????????? Translated title: La respuesta temprana en la aparición del virus de la gripe A(H7N9) en humanos en China: el papel central del intercambio de información y la comunicación pública a tiempo

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          Abstract

          Problem In 2003, China’s handling of the early stages of the epidemic of severe acute respiratory syndrome (SARS) was heavily criticized and generally considered to be suboptimal. Approach Following the SARS outbreak, China made huge investments to improve surveillance, emergency preparedness and response capacity and strengthen public health institutions. In 2013, the return on these investments was evaluated by investigating China’s early response to the emergence of avian influenza A(H7N9) virus in humans. Local setting Clusters of human infection with a novel influenza virus were detected in China – by national surveillance of pneumonia of unknown etiology – on 26 February 2013. Relevant changes On 31 March 2013, China notified the World Health Organization (WHO) of the first recorded human infections with A(H7N9) virus. Poultry markets – which were rapidly identified as a major source of transmission of A(H7N9) to humans – were closed down in the affected areas. Surveillance in humans and poultry was heightened and technical guidelines were quickly updated and disseminated. The health authorities collaborated with WHO in risk assessments and risk communication. New cases were reported promptly and publicly. Lessons learnt The relevant infrastructures, surveillance systems and response capacity need to be strengthened in preparation for future emergencies caused by emerging or existing disease threats. Results of risk assessments and other data should be released promptly and publicly and such release should not jeopardize future publication of the data in scientific journals. Coordination between public health and veterinary services would be stronger during an emergency if these services had already undertaken joint preparedness planning.

          Translated abstract

          Résumé Problème En 2003, la gestion des premiers stades de l'épidémie du syndrome respiratoire aigu sévère (SRAS) par la Chine a été fortement critiquée et généralement considérée comme non optimale. Approche Après l'épidémie de SRAS, la Chine a investi massivement pour améliorer sa surveillance, sa préparation aux situations d'urgence et sa capacité de réponse, et pour renforcer les établissements de santé publique. En 2013, le retour sur ces investissements a été évalué par l'examen de la réponse précoce de la Chine à l'émergence du virus de la grippe aviaire A(H7N9) chez l'homme. Environnement local Des cas d'infection humaine au nouveau virus de la grippe ont été détectés en Chine le 26 février 2013 par le système de surveillance nationale des pneumonies d'étiologie inconnue. Changements significatifs Le 31 mars 2013, la Chine a notifié à l'Organisation mondiale de la Santé (OMS) les premières infections humaines au virus A(H7N9) enregistrées. Les marchés de volaille – qui ont été rapidement identifiés comme des sources majeures de transmission du virus A(H7N9) à l'homme – ont été fermés dans les zones touchées. La surveillance a été renforcée chez l'homme et les volailles, et les recommandations techniques ont été rapidement mises à jour et diffusées. Les autorités sanitaires ont collaboré avec l'OMS dans les domaines de l'évaluation des risques et de la communication des risques. Les nouveaux cas ont été signalés rapidement et publiquement. Leçons tirées Les infrastructures concernées, les systèmes de surveillance et la capacité de réponse doivent être renforcés en prévision des futures urgences causées par les menaces de maladies émergentes ou existantes. Les résultats des évaluations des risques et les autres données doivent être communiqués rapidement et publiquement, et ces communications ne doivent pas compromettre la publication ultérieure des données dans les revues scientifiques. La coordination entre les services de santé publique et les services vétérinaires serait plus forte pendant une situation d'urgence si ces services avaient déjà engagé une planification préalable commune.

          Translated abstract

          Resumen Situación En 2003, la gestión de China de las primeras etapas de la epidemia del síndrome respiratorio agudo severo (SRAS) se criticó duramente y se consideró insuficiente por lo general. Enfoque Tras el brote de SRAS, China realizó grandes inversiones para mejorar la vigilancia, la preparación para emergencias y la capacidad de respuesta, así como para fortalecer las instituciones de salud pública. En 2013, se evaluó la rentabilidad de estas inversiones mediante una investigación sobre la respuesta temprana de China a la aparición del virus de la gripe aviar A(H7N9) en humanos. Marco regional El 26 de febrero de 2013 se detectaron grupos de infecciones humanas con el nuevo virus de la gripe en China mediante la vigilancia nacional de la neumonía de etiología desconocida. Cambios importantes El 31 de marzo de 2013, China comunicó a la Organización Mundial de la Salud (OMS) las primeras infecciones humanas del virus A(H7N9) registradas. Los mercados de aves de corral, que se identificaron de inmediato como una fuente importante de transmisión del virus A(H7N9) a los humanos, se cerraron en las zonas afectadas. Se reforzó la vigilancia en humanos y aves de corral a la vez que se actualizaron y difundieron las directrices técnicas con rapidez. Las autoridades de salud colaboraron con la OMS en la evaluación de los riesgos y la comunicación de los riesgos. De inmediato, se anunciaron los nuevos casos públicamente. Lecciones aprendidas Deben reforzarse las infraestructuras pertinentes, los sistemas de vigilancia y la capacidad de respuesta como preparación a las futuras emergencias causadas por la amenaza de enfermedades nuevas o existentes. Los resultados de las evaluaciones de riesgo y el resto de datos deben divulgarse rápida y públicamente, pero dicha divulgación no debe poner en peligro la futura publicación de los datos en las revistas científicas. La coordinación entre la salud pública y los servicios veterinarios sería más fuerte durante una emergencia si estos servicios planificaran de antemano la preparación conjunta.

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          Most cited references 25

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          Human infection with a novel avian-origin influenza A (H7N9) virus.

          Infection of poultry with influenza A subtype H7 viruses occurs worldwide, but the introduction of this subtype to humans in Asia has not been observed previously. In March 2013, three urban residents of Shanghai or Anhui, China, presented with rapidly progressing lower respiratory tract infections and were found to be infected with a novel reassortant avian-origin influenza A (H7N9) virus. We obtained and analyzed clinical, epidemiologic, and virologic data from these patients. Respiratory specimens were tested for influenza and other respiratory viruses by means of real-time reverse-transcriptase-polymerase-chain-reaction assays, viral culturing, and sequence analyses. A novel reassortant avian-origin influenza A (H7N9) virus was isolated from respiratory specimens obtained from all three patients and was identified as H7N9. Sequencing analyses revealed that all the genes from these three viruses were of avian origin, with six internal genes from avian influenza A (H9N2) viruses. Substitution Q226L (H3 numbering) at the 210-loop in the hemagglutinin (HA) gene was found in the A/Anhui/1/2013 and A/Shanghai/2/2013 virus but not in the A/Shanghai/1/2013 virus. A T160A mutation was identified at the 150-loop in the HA gene of all three viruses. A deletion of five amino acids in the neuraminidase (NA) stalk region was found in all three viruses. All three patients presented with fever, cough, and dyspnea. Two of the patients had a history of recent exposure to poultry. Chest radiography revealed diffuse opacities and consolidation. Complications included acute respiratory distress syndrome and multiorgan failure. All three patients died. Novel reassortant H7N9 viruses were associated with severe and fatal respiratory disease in three patients. (Funded by the National Basic Research Program of China and others.).
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            Coronavirus as a possible cause of severe acute respiratory syndrome.

            An outbreak of severe acute respiratory syndrome (SARS) has been reported in Hong Kong. We investigated the viral cause and clinical presentation among 50 patients. We analysed case notes and microbiological findings for 50 patients with SARS, representing more than five separate epidemiologically linked transmission clusters. We defined the clinical presentation and risk factors associated with severe disease and investigated the causal agents by chest radiography and laboratory testing of nasopharyngeal aspirates and sera samples. We compared the laboratory findings with those submitted for microbiological investigation of other diseases from patients whose identity was masked. Patients' age ranged from 23 to 74 years. Fever, chills, myalgia, and cough were the most frequent complaints. When compared with chest radiographic changes, respiratory symptoms and auscultatory findings were disproportionally mild. Patients who were household contacts of other infected people and had older age, lymphopenia, and liver dysfunction were associated with severe disease. A virus belonging to the family Coronaviridae was isolated from two patients. By use of serological and reverse-transcriptase PCR specific for this virus, 45 of 50 patients with SARS, but no controls, had evidence of infection with this virus. A coronavirus was isolated from patients with SARS that might be the primary agent associated with this disease. Serological and molecular tests specific for the virus permitted a definitive laboratory diagnosis to be made and allowed further investigation to define whether other cofactors play a part in disease progression.
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              Human infections with the emerging avian influenza A H7N9 virus from wet market poultry: clinical analysis and characterisation of viral genome

              Summary Background Human infection with avian influenza A H7N9 virus emerged in eastern China in February, 2013, and has been associated with exposure to poultry. We report the clinical and microbiological features of patients infected with influenza A H7N9 virus and compare genomic features of the human virus with those of the virus in market poultry in Zhejiang, China. Methods Between March 7 and April 8, 2013, we included hospital inpatients if they had new-onset respiratory symptoms, unexplained radiographic infiltrate, and laboratory-confirmed H7N9 virus infection. We recorded histories and results of haematological, biochemical, radiological, and microbiological investigations. We took throat and sputum samples, used RT-PCR to detect M, H7, and N9 genes, and cultured samples in Madin-Darby canine kidney cells. We tested for co-infections and monitored serum concentrations of six cytokines and chemokines. We collected cloacal swabs from 86 birds from epidemiologically linked wet markets and inoculated embryonated chicken eggs with the samples. We identified and subtyped isolates by RT-PCR sequencing. RNA extraction, complementary DNA synthesis, and PCR sequencing were done for one human and one chicken isolate. We characterised and phylogenetically analysed the eight gene segments of the viruses in the patient's and the chicken's isolates, and constructed phylogenetic trees of H, N, PB2, and NS genes. Findings We identified four patients (mean age 56 years), all of whom had contact with poultry 3–8 days before disease onset. They presented with fever and rapidly progressive pneumonia that did not respond to antibiotics. Patients were leucopenic and lymphopenic, and had impaired liver or renal function, substantially increased serum cytokine or chemokine concentrations, and disseminated intravascular coagulation with disease progression. Two patients died. Sputum specimens were more likely to test positive for the H7N9 virus than were samples from throat swabs. The viral isolate from the patient was closely similar to that from an epidemiologically linked market chicken. All viral gene segments were of avian origin. The H7 of the isolated viruses was closest to that of the H7N3 virus from domestic ducks in Zhejiang, whereas the N9 was closest to that of the wild bird H7N9 virus in South Korea. We noted Gln226Leu and Gly186Val substitutions in human virus H7 (associated with increased affinity for α-2,6-linked sialic acid receptors) and the PB2 Asp701Asn mutation (associated with mammalian adaptation). Ser31Asn mutation, which is associated with adamantane resistance, was noted in viral M2. Interpretation Cross species poultry-to-person transmission of this new reassortant H7N9 virus is associated with severe pneumonia and multiorgan dysfunction in human beings. Monitoring of the viral evolution and further study of disease pathogenesis will improve disease management, epidemic control, and pandemic preparedness. Funding Larry Chi-Kin Yung, National Key Program for Infectious Diseases of China.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                bwho
                Bulletin of the World Health Organization
                Bull World Health Organ
                World Health Organization (Genebra )
                0042-9686
                April 2014
                : 92
                : 4
                : 303-308
                Affiliations
                [1 ] World Health Organization Office in China Peoples R China
                [2 ] Chinese Centre for Disease Control and Prevention Peoples R China
                Article
                S0042-96862014000400303
                10.2471/BLT.13.125989

                http://creativecommons.org/licenses/by/4.0/

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                Product Information: SciELO Public Health
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                Health Policy & Services

                Public health

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